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FEGS New York Society for the Deaf Title I Case Management Program

FEGS New York Society for the Deaf Title I Case Management Program. Quality Improvement Project Improving Client Involvement in Primary Care Joseph Santini. RWCA Title I Case Management Program. Client Population Served: Deaf and HIV+/AIDS Staff: Joseph Santini

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FEGS New York Society for the Deaf Title I Case Management Program

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  1. FEGSNew York Society for the Deaf Title I Case Management Program Quality Improvement Project Improving Client Involvement in Primary Care Joseph Santini

  2. RWCA Title I Case Management Program • Client Population Served: Deaf and HIV+/AIDS • Staff: Joseph Santini • Services: Case Management, Counseling, Individual Support Groups • Additional Services available at the agency: Chemical Dependency and Mental Health, also Employment Svcs.

  3. “Improving Client Involvement in Primary Care” What are we measuring? • % of clients with T-Cell and Viral Load test results documented (at least every 3 months) • % of clients with current HAART medication documented Each indicator was 0% at baseline.

  4. Review of Current Process • When identifying an area for improvement we noted that no communication was occurring/documented between the client and case manger regarding the relationship of T-Cell and Viral Load test results to physical health • Clients also had difficult time demonstrating HAART adherence Root Causes? • A standardized system for collecting primary care status measures did not exist • Issues around health literacy and HIV knowledge • Issues around communicating effectively with health care providers • General literacy issues for bilingual clients and severely language-deprived individuals, many of whom are immigrants

  5. Improvement Strategy Pilot Tested • New policy encourages consumers to self-report specific laboratory results and HAART regimen • NYSDOH AIDS Institute Health Journal is distributed to clients to assist them in self-tracking of medical information.

  6. Pilot Test Plan 1) Test the two ideas (simultaneously) with 4 clients. 2) Data Collection: Qualitative: Patients’ impressions of the usefulness of Health Journal Case Manager’s impression of the Health Journal & new policy focusing on client engagement in primary care Quantitative: # (%) of patients reporting T-Cell Viral Load test results # (%) of patients reporting HAART regimen

  7. Qualitative Results • 2 patients (50%) expressed that they were excited about being able to collect and track their primary care info • 1 patient (25%) lost the health journal card • 1 patient (25%) was unable to understand/retain the purpose of health journal

  8. Qualitative ResultsContinued • Clients - “The format of the Health Journal card should be simplified.” “The font size is too small to read.” • Case Manager – “The intervention engages clients more in the reality of their care” The Health Journal: simplifies paperwork; reduces time in collecting info; & eliminates the need to call PCPs.

  9. Qualitative results (cont.) • Consumers enjoyed the opportunity to engage in their health care, but PCPs not always receptive • Case Manager: enabled me to realize gaps in client education and provide an easy tool for continual re-education

  10. Quantitative Results • 50% of clients receiving the intervention were able to self-report their T-Cell and VL test results along with adherence to HAART. A 50% improvement from the baseline (0%) was measured as a result of the intervention

  11. Lessons Learned • The change in policy/systems to improve client engagement in their primary care clearly has potential • While the Health Journal card may be linguistically complicated for the target population w/ modification the concept can have a positive impact upon our clients’ engagement in their own health care • PCP needs to be informed and encouraged to participate as they need to account for the delay in communication due to ASL interpreting (if any)

  12. Next Steps • Refine the Health Journal card w/ client input • Test refined card on a small scale • Measure the success of the refinement: - Survey clients re: ease of use; readability; format - % of clients reporting lab and HAART

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